Vacuum Devices for Erectile Dysfunction Treatment

Erectile dysfunction is a fairly common condition that affects the functional capacity of an adult male to maintain and sustain penile erection during the act of intercourse. According to latest estimates (1), the prevalence of ED is approximately 2% in young adult males; however, the risk increases steadily with advancing age. For example, based on latest data (2), the prevalence of ED in males over the age of 40 years is 40%. In addition, by the age of 65 years, more than 70% males experience some degree of erectile dysfunction.Fortunately, a wide variety of treatment methods and devices are available that can effectively manage the disturbing symptoms of ED to restore optimal quality of sexual life.

What are Vacuum Devices?

Vacuum constriction devices are one of the most reliable and effective methods of management in moderate to severe erectile dysfunction. A VCD or vacuum constriction device consists of two main components:

• An acrylic cylinder like device that is used to create vacuum pressure
• A manual pump that can be directly attached to the distal end of the penis with the help of a band.

The pump once attached can be used to create vacuum that can help in maintaining penile erection. The attached ring in turn helps in maintaining the induced erection for controlled period of time.

How to Use a VCD (Vacuum Constriction Device)?

It is highly recommended to seek the advice/ services of a primary care provider to learn how to use vacuum constriction device. The working principle of most VCSs is similar and involve these primary steps:

• Position the pump on your flaccid penis. Make sure it is in a position to allow manual pumping by hand.
• Next step is to create the vacuum by pumping the air out. The vacuum helps in promoting the accumulation of blood in the sinuses (shaft of the penis) to maintain optimal erection.
• After achieving the desired erection, apply small quantity of a lubricant to allow maximal retention of the band over the penis.
• Release the vacuum and remove the pump after achieving the desired erection.
• The band should be left in place to sustain effective erection during the act of intercourse. The band can be placed for constriction for up to 30 minutes.

It is to be noted that whenever these vacuum constriction devices are purchased check for the ‘quick release pattern’. It is mainly because the risk of penile injuries is much higher with delayed pattern VCDs.

How Well Does These Devices Work?

According to several research studies the effectiveness and safety of vacuum constriction devices is fairly high. The patient satisfaction scores ranges from 35% - 98% (3, 4). It is observed that response to VCDs and patient satisfaction is dependent on several factors like; severity of erectile dysfunction, response to other devices and ED therapies and partner preferences. Study reported in the Journal of Sexual Medicine (4) suggested that individuals who respond poorly to intracavernosal pharmacotherapy are more likely to report high satisfaction scores with VCDs.

Who Should Use Vacuum Constriction Device?

Vacuum constriction devices are considered fairly safe and useful in patients with transient or chronic history of erectile dysfunctions due to medical or psychological reasons. In addition, it is also a superior modality of care for ED management in patients with:

• Compromised blood flow to penis (due to atherosclerosis or related vascular conditions)
• Long standing or poorly managed diabetes mellitus
• Individuals with a history of colon and prostate surgeries
• Individuals with history of anxiety and depression

Vacuum constriction devices are not recommended for patients with:

• A known history of congenital or acquired bleeding problem
• Individuals who are at risk of developing priapism (prolonged painful erection)
• Known history of sickle cell anemia and leukemia

Although VCDs are generally considered as second line of ED management, but for patients who underwent prostate surgery (such as prostatectomy) or in individuals who cannot use phosphodiesterase inhibitors, it should be considered as first line of management (4).

Side Effects of Vacuum Constriction Device

Although VCDs are very safe for erectile dysfunction management, it is important to keep in mind that erection is induced through artificial suction and hence differs from the natural erection in terms of physiology and mechanics. Some common side effects that are reported with vacuum device use are:

• Purple discoloration of penis
• Numbness and discomfort in penis
• Appearance of black and blue bruises on localized spots (that are usually painless)
• Compromised or decreased ejaculation force
• The constriction band placed for constant erection may trap the ejaculating fluid (semen). This condition is not painful and does not interfere with climax or intercourse pleasure.

Cost of the Device

Different brands and types of vacuum constriction devices are available in the market with varying prices ranging from $300 to $500. The battery mode devices cost a little more. Some VCD are available with prescription while some can be purchased without prescription.References:

1. Selvin, E., Burnett, A. L., & Platz, E. A. (2007). Prevalence and risk factors for erectile dysfunction in the US. The American journal of medicine, 120(2), 151-157.
2. Grover, S. A., Lowensteyn, I., Kaouache, M., Marchand, S., Coupal, L., DeCarolis, E., ... & Defoy, I. (2006). The prevalence of erectile dysfunction in the primary care setting: importance of risk factors for diabetes and vascular disease. Archives of internal medicine, 166(2), 213-219.
3. Dutta, T. C., & Eid, J. F. (1999). Vacuum constriction devices for erectile dysfunction: a long-term, prospective study of patients with mild, moderate, and severe dysfunction. Urology, 54(5), 891-893.
4. Brison, D., Seftel, A., & Sadeghi‐Nejad, H. (2013). The resurgence of the vacuum erection device (VED) for treatment of erectile dysfunction. The journal of sexual medicine, 10(4), 1124-1135.
5. Raina, R., Agarwal, A., Allamaneni, S. S., Lakin, M. M., & Zippe, C. D. (2005). Sildenafil citrate and vacuum constriction device combination enhances sexual satisfaction in erectile dysfunction after radical prostatectomy. Urology, 65(2), 360-364.